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The Integrated Diagnostic Approach in General Medicine
Published in Giuseppe Mancia, Guido Grassi, Konstantinos P. Tsioufis, Anna F. Dominiczak, Enrico Agabiti Rosei, Manual of Hypertension of the European Society of Hypertension, 2019
Andrzej Więcek, Aleksander Prejbisz, Andrzej Januszewicz
Based on the BP measurements, pulse pressure (PP) can be calculated by subtracting diastolic BP from systolic BP. There is abundant evidence that the increased PP in elderly subjects is a marker for central artery stiffness. ESC/ESH 2018 defined elevated PP ≥60 mmHg in the elderly as asymptomatic HMOD. It has been also established that PP is an independent risk factor for CV disease and may improve risk prediction (1,13–15).
Cardiovascular System:
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
The arteries move blood away from the heart and, with the exception of the pulmonary artery, carry oxygenated blood. The elastic fibers within the arterial wall allow for high compliance or “expandability.” The elastic arteries, or conducting arteries, include the aorta and its major branches. They range in diameter from 1 to 2.5 cm and contain a high proportion of elastin within the tunica layers. These arteries act as a pressure reservoir that expands as it receives blood from the left ventricle in systole and then recoils during diastole, helping to smooth out the pulsatile flow seen in these vessels. The thick wall and high percentage of elastic tissues help the vessel withstand the high and changing pressures. The peak arterial pressure (or systolic pressure) is seen during ventricular ejection, while the minimal arterial pressure (or diastolic pressure) occurs just before ejection begins. The difference in systolic and diastolic pressure is called the pulse pressure. It is dependent on the stroke volume ejected by the ventricle, as well as the vessel’s elastic properties that determine arterial compliance. With aging, the arterial vessel walls can stiffen (arteriosclerosis) and result in a higher pulse pressure. This will be discussed in more detail in Chapters 6 and 11.
Hypertension
Published in Clive Handler, Gerry Coghlan, Marie-Anne Essam, Preventing Cardiovascular Disease in Primary Care, 2018
Clive Handler, Gerry Coghlan, Marie-Anne Essam
In patients under 50 years of age, diastolic blood pressure is a stronger predictor of fatal and non-fatal coronary artery disease. Above the age of 60 years diastolic pressure is inversely related to coronary risk so that pulse pressure (systolic pressure minus diastolic pressure) is a better predictor of cardiovascular events than systolic blood pressure. The increasing systolic blood pressure increases left ventricular work and the risk of hypertrophy. The lowering of the diastolic blood pressure compromises coronary blood flow. Thus a blood pressure of 150/85 mmHg carries a higher risk than does a blood pressure of 150/95 mmHg in patients over 60 years of age. A wide pulse pressure is an important risk factor, and lowering of the systolic blood pressure alone is a primary objective of treating hypertension, but difficult to achieve. Pulse pressure is also highly predictive of cardiovascular risk. This is because the higher the pulse pressure, the greater the pressure stress on arterial walls, and the more likely it is that there will be organ damage. A blood pressure recording of 150/95 mmHg has different implications for a 70-year-old man than for a 35-year-old man. The 70-year-old man has a higher absolute cardiovascular risk, but the 35-year-old man has a higher relative risk compared with ‘normal’ men of his age.
Ambulatory blood pressure in relation to interaction between dietary sodium intake and serum uric acid in the young
Published in Blood Pressure, 2021
Wei Zhang, Jian-Zhong Xu, Xiao-Hong Lu, Hua Li, Dian Wang, Ji-Guang Wang
The observed widening pulse pressure associated with hyperuricaemia and dietary sodium intake in the present study is resulted from the lower diastolic BP instead of higher systolic BP. This phenomenon in the young is different from the widening of pulse pressure in elderly people with isolated systolic hypertension, in whom it is the consequence of arterial stiffness and higher systolic BP [19]. The mechanism of the widening of pulse pressure and lower diastolic BP in the young is incompletely understood. A speculative mechanism is that hyperuricaemia [20] and excessive sodium intake [21] trigger sympathetic activity, and in turn dilatates arterials, which reduces peripheral resistance and diastolic BP. However, the sympathetic overactivation in the long run will cause arterial stiffness and then higher systolic BP, as observed in those patients with the combination of hyperuricaemia and high dietary sodium intake.
Central hemodynamics in relation to low-level environmental lead exposure
Published in Blood Pressure, 2020
Cai-Guo Yu, Fang-Fei Wei, Zhen-Yu Zhang, Lutgarde Thijs, Wen-Yi Yang, Blerim Mujaj, Ying-Mei Feng, José Boggia, Harry A. Roels, Harry A. J. Struijker-Boudier, Tim S. Nawrot, Peter Verhamme, Jan A. Staessen
Study nurses administered validated questionnaires, inquiring into each participant’s medical history, previous occupations, exposure to heavy metals at work or during leisure time, smoking and drinking habits, intake of medications, lifestyle and socioeconomic status. We coded socioeconomic status according to the methods of the UK Office of Population Censuses and Surveys [28] and condensed the 20 categories into a scale with scores ranging from 1 to 3, reflecting the gradient from low to high socioeconomic position [29]. After participants had rested for 5 minutes in the supine position, nurses measured blood pressure twice to the nearest 2 mm Hg on the right arm, using a standard mercury sphygmomanometer (Riester GmbH, Jungingen, Germany) fitted with the appropriate cuff size according to European guidelines. Pulse pressure was systolic minus diastolic blood pressure. Mean arterial pressure was diastolic pressure plus one third of pulse pressure. Hypertension was a brachial blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic or use of antihypertensive drugs.
Central hemodynamics in relation to blood lead in young men prior to chronic occupational exposure
Published in Blood Pressure, 2019
Cai-Guo Yu, Fang-Fei Wei, Wen-Yi Yang, Zhen-Yu Zhang, Blerim Mujaj, Lutgarde Thijs, Ying-Mei Feng, José Boggia, Tim S. Nawrot, Harry A. J. Struijker-Boudier, Jan A. Staessen
Study nurses administered validated questionnaires, inquiring into each worker’s medical history, previous occupations, exposure to heavy metals at work or during leisure time, smoking and drinking habits, intake of medications and lifestyle. Ethnicity was self-reported. The umbilicus and greater trochanter were the landmarks for measuring waist and hip circumference. After the workers had rested for 5 minutes in the supine position, nurses measured blood pressures twice to the nearest 2 mm Hg on the right arm, using a standard mercury sphygmomanometer (Riester GmbH, Jungingen, Germany) fitted with the appropriate cuff size according to European guidelines [24]. Pulse pressure was systolic minus diastolic blood pressure. Mean arterial pressure was diastolic pressure plus one third of pulse pressure. Hypertension was a brachial blood pressure of at least 140 mm Hg systolic or 90 mm Hg diastolic.